The only thing that seems to surround the Patient Protection and Affordable Care Act even more than controversy is confusion.
This federal overhaul of the U.S. health care system - commonly called Obamacare - was written into law by President Barack Obama in March 2010, and has been the subject of debate ever since, with most disagreements falling along party lines.
The House of Representatives has tried to repeal the bill more than 30 times, and numerous states have challenged the legislation in court. The U.S. Supreme Court has upheld the law, but critics continue to question its cost, scope and consequences.
According to a number of public opinion polls, a slim majority of Americans do not support the bill overall, though certain elements of it are well liked.
For example, the new rule that insurance companies cannot deny people coverage for pre-existing conditions is widely popular.
But the mandate that individuals must have insurance coverage or pay a penalty is not.
Polls also show that political affiliation heavily influences opinion on the matter.
As a recent example, an August 2012 poll by the nonpartisan Kaiser Family Foundation showed that only 8 percent of republicans had a favorable view of the law overall, while that number jumps to 64 percent among Democrats.
One thing both parties agree on is the importance of the issue - in that same Kaiser poll, both Democrats and Republicans listed health care and insurance costs, along with Medicare, among their top concerns when deciding which presidential candidate to vote for this fall.
Knowing that, it's no surprise the subject has made itself at home within campaign rhetoric. This being an election year, health care reform is as hot a topic as ever, popping up all over in political ads.
The information that gets out to people sends mixed messages or contains exaggerations, making it hard for people to really know what's what.
Perham Health CEO Chuck Hofius presented some information about the Affordable Care Act to Perham community leaders at a meeting last week.
He said Perham Health, along with the hospital industry as a whole across the nation, is in support of the reform, mainly "because there are just so many people not insured in our country. It's bad for their health, and it's bad for our industry."
When people are uninsured, he explained, they usually skip preventative visits and wait longer to receive care when they know they're sick.
When they do come in, their bill ends up being much bigger than it would have been. Often, they can't afford to pay, so their care ends up as bad debt or "charity care," said Hofius.
The law is expected to provide 32 million more Americans with health insurance, though some 20 million will remain uninsured.
How the reform will specifically impact Perham Health is still not entirely clear. Most of the provisions of the law don't start until 2014, but it'll be a number of years after that before smaller hospitals feel its total effects.
One thing that's certain is the new system increases focus on quality of care and patient satisfaction. In response, Hofius said, Perham Health will continue its own focus on quality.
Eventually, partial Medicare payments will be withheld from lower-performing hospitals.
About half the cost of the health care reform law is paid for by reductions to health care providers and Medicare health plans.
The new rules could eventually benefit health care facilities in Minnesota: Hofius said the state "has always been a low-cost, high-quality state, but yet we get paid less than other high-cost, low-quality states. We're hoping to shift money here. We could see a potential increase in payment in the future."
Cost of care is also a focus of the reform; as such, Hofius said Perham Health will be taking steps to decrease costs.
This is one area where Hofius feels the reform could go even farther, providing more funding for preventative care to help drive down the cost of care overall.
"But," he added, "step No. 1 is to get more people covered, and then you start tweaking the system. You have to get more people covered, you have to start there. And the Affordable Care Act certainly does that."
More information about the Affordable Care Act
Cost: Approximately half the cost of the health reform law is paid for by reductions to hospitals and other health providers and Medicare health plans.
The other half will be paid for by taxes (or fees or penalties) on certain employers and individuals that choose not to purchase insurance, as well as on such things as tanning beds and medical equipment.
The cost of the law is one of the most contentious parts of it. Despite the controversy, nonpartisan economists, as well as the Congressional budget office, project that federal health care spending will actually be less over the next 10 years with the Affordable Care Act than if it had not been passed.
Coverage: The law will provide 32 million more Americans with health insurance.
Coverage excludes undocumented, illegal residents. An estimated 20 million people will remain uninsured.
Young adults under age 26 are allowed to stay on their parent's health insurance, regardless of whether they are students, married, living out of the home or claimed as a dependent on their parents' tax returns.
Exchanges: Starting in 2014, state-based insurance markets will be mandated to offer health insurance plans for individuals and small businesses (larger businesses may be allowed to buy through these Exchanges starting in 2017).
The Exchanges will be run by a nonprofit or government entity. Federal funding for start-up costs of these state Exchanges has been available since 2011, and will continue through 2015.
All Exchanges will offer standard benefit sets, including multiple comprehensive plans with preventive, primary care, ER, mental and chemical health, hospitalization, outpatient and more.
At least two plans in each Exchange must be offered by multi-state insurers with federal employee plan contracts; at least one multi-state insurer must be nonprofit and must be licensed by the state.
Transparency: Under the health reform law, health insurers must be more transparent about medical loss ratios, payment claims and policies, rating practices, clinical services expenses, quality improvement costs, non-claims costs and premium revenues.
Hospitals must be more transparent about charges for services, hospital-acquired infections, measures used for readmissions, measures used for value-based purchasing and inpatient psychiatric unit measures.
(Marie Nitke writes for the East Otter Tail Focus newspaper of Perham)